Shams-Molkara Sheida, Mendes Vitor, Verdy François, Perez Maria-Helena, Di Bernardo Stefano, Kirsch Matthias, Hosseinpour Amir-Reza
Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Perfusion Unit, Service of Cardiac Surgery, Geneva University Hospital, Geneva, Switzerland.
Pediatr Cardiol. 2025 Jan 8. doi: 10.1007/s00246-024-03748-7.
Cardiac surgery, both adult and pediatric, has developed very rapidly and impressively over the past 7 decades. Pediatric cardiac surgery, in particular, has revolutionized the management of babies born with congenital heart disease such that now most patients reach adult life and lead comfortable lives. However, these patients are at risk of cerebral lesions, which may be due to perioperative factors, such as side effects of cardiopulmonary bypass and/or anesthesia, and non-perioperative factors such as chromosomal anomalies (common in children with congenital heart disease), the timing of surgery, number of days on the intensive care unit, length of hospitalization and other hospitalizations in the first year of life. The risk of cerebral lesions is particularly relevant to pediatric cardiac surgery given that cerebral metabolism is about 30% higher in neonates, infants and young children compared to adults, which renders their brain more susceptible to ischemic/hypoxic injury. This issue has been a major concern throughout the history of cardiac surgery such that many preventive measures have been implemented over the years. These measures, however, have had only a modest impact and cerebral lesions continue to be a major concern. This is the subject of this review article, which aims to outline these protective measures, offer possible explanations of why these have not resolved the issue, and suggest possible actions that ought to be taken now.
在过去的70年里，成人和小儿心脏外科都取得了非常迅速且令人瞩目的发展。尤其是小儿心脏外科，彻底改变了对患有先天性心脏病婴儿的治疗方式，以至于现在大多数患者都能活到成年并过上舒适的生活。然而，这些患者存在脑部病变的风险，这可能是由于围手术期因素，如体外循环和/或麻醉的副作用，以及非围手术期因素，如染色体异常（在先天性心脏病儿童中常见）、手术时机、重症监护病房的天数、住院时间以及出生后第一年的其他住院情况。鉴于新生儿、婴儿和幼儿的脑代谢比成年人高约30%，这使得他们的大脑更容易受到缺血/缺氧损伤，因此脑部病变的风险与小儿心脏外科尤为相关。在心脏外科的整个历史中，这个问题一直是一个主要关注点，多年来已经实施了许多预防措施。然而，这些措施只产生了适度的影响，脑部病变仍然是一个主要问题。这就是这篇综述文章的主题，其目的是概述这些保护措施，对为什么这些措施没有解决问题提供可能的解释，并提出现在应该采取的可能行动。
